Endocrine response in cardiogenic shock complicating myocardial infarction: the prognostic value of growth hormone and IGF-1.

Abstract

Cardiogenic shock (CS) is a life-threatening complication of acute myocardial infarction (AMI) with high mortality. Hormonal alterations during CS may offer prognostic insights. While growth hormone (GH) dynamics have been studied in heart failure, the role of insulin-like growth factor-1 (IGF-1) in CS remains unclear. IGF-1 exerts cardioprotective effects, including reducing myocardial apoptosis after ischemia-reperfusion injury. This study examines temporal changes in GH and IGF-1 levels in CS and their prognostic value. The Halle-Cardiogenic Shock Registry included 41 AMI patients with CS. GH and IGF-1 levels were measured at admission and on day 1, 2 and 4 post-percutaneous coronary intervention. Differences were analyzed between survivors and non-survivors, as well as by age (<70 vs ≥70 years) and sex. We found that at admission, GH levels (2.86 ± 0.78 μg/L) were within the normal range in 75.6% of patients and showed no significant differences between survivors and non-survivors. IGF-1 levels (76.23 ± 5.67 μg/L) were at the lower end of normal and declined to 66.8 μg/L at 48-72 h (P = 0.14). Non-survivors had a more rapid IGF-1 decline, while survivors maintained stable levels. IGF-1 was higher in younger and male patients, while older and female patients showed a greater decline. We conclude that GH levels remained stable and lacked prognostic value, while IGF-1 decline correlated with disease severity and possible hepatic dysfunction. IGF-1 may serve as a biomarker for risk stratification and a therapeutic target for metabolic regulation and recovery in CS, warranting further investigation.